Streptococcus Pneumoniae (Pneumococcus)


Epidemiology

Risk Factors


Microbiology


Diagnosis

Sputum Culture (see Sputum Culture, [[Sputum Culture]])

CXR/Chest CT Pattern (see xxxx, [[xxxx]])x


Clinical Manifestations

Hematologic Manifestations

Hemolytic Anemia (see Hemolytic Anemia, [[Hemolytic Anemia]])

Hemolytic-Uremic Syndrome (see Thrombotic Microangiopathy, [[Thrombotic Microangiopathy]])

Otolaryngologic Manifestations

Pulmonary Manifestations

Necrotizing Pneumonia (see Necrotizing Pneumonia and Pulmonary Gangrene, [[Necrotizing Pneumonia and Pulmonary Gangrene]])

Pneumonia (see Pneumonia, [[Pneumonia]])

Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])

Sepsis (see Sepsis, [[Sepsis]])


Prevention-Pneumoccocal Vaccination

VACCINATION

Pneumococcal Conjugate Vaccine 13 (PCV13) (Prevnar 13)

General Information

  • Vaccine Contains Capsular Polysaccharides from 13 Pneumococcal Serotypes Covalently Linked to a Non-Toxic Protein Which Resembles Diphtheria Toxin: linking allows capsular antigens to be immunogenic to children <2 y/o
    • PCV13 Stimulates Mucosal Antibody: functions to suppress nasal carriage of the covered pneumococcal serotypes -> this prevents spread of these serotypes from small childre (the usual reservoir for pneumococcus) to unvaccinated children and adults (so called, “herd effect”)
  • General Indications
    • Children <2 y/o
    • Selected Adults: see below
      • 2012: US Advisory Committee on Immunization Practices (ACIP) Recommended PCV13 for Selected High-Risk Adult Populations
      • 2014: ACIP Recommended PCV13 for All Adults ≥65 y/o and Patients >2 y/o with Conditions Which Increase Risk for Pneumococcal Infection

Adult Groups Recommended for Vaccination with PCV13

  • Immunocompetent
    • Cerebrospinal Fluid Leak
    • Cochlear Implant
  • Immunocompromised
    • Asplenia (see Asplenia, [[Asplenia]])
      • Sickle Cell Disease/Other Hemoglobinopathy
      • Congenital/Acquired Asplenia
    • Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
    • Congenital/Acquired Immunodeficiency
      • B-Cell/T-Cell Deficiency
      • Complement Deficiency (Especially C1, C2, C3, and C4)
      • Phagocytic Disorders (Excluding Chronic Granulomatous Disease)
    • Hodgkin’s Disease (see Hodgkin’s Disease, [[Hodgkins Disease]])
    • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Iatrogenic Immunosuppression
    • Leukemia
    • Lymphoma (see Lymphoma, [[Lymphoma]])
    • Malignancy
    • Multiple Myeloma (see Multiple Myeloma, [[Multiple Myeloma]])
    • Nephrotic Syndrome (see Nephrotic Syndrome, [[Nephrotic Syndrome]])
    • Solid Organ Transplant

23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) (Pneumovax 23)

General Information

  • Vaccine Contains Capsular Polysaccharides from 23 Pneumococcal Serotypes: these serotypes account for 60% of human pneumococcal infections
  • General Indications
    • Children ≥2 y/o: polysaccharides are poorly immunogenic in children <2 y/o
    • Selected Adults: see below
  • Duration of Antibody Response: 10 yrs

Adult Groups Recommended for Vaccination with PPSV23

  • Immunocompetent
  • Immunocompromised
    • Asplenia (see Asplenia, [[Asplenia]])
      • Sickle Cell Disease/Other Hemoglobinopathy
      • Congenital/Acquired Asplenia
    • Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
    • Congenital/Acquired Immunodeficiency
      • B-Cell/T-Cell Deficiency
      • Complement Deficiency (Especially C1, C2, C3, and C4)
      • Phagocytic Disorders (Excluding Chronic Granulomatous Disease)
    • Hodgkin’s Disease (see Hodgkin’s Disease, [[Hodgkins Disease]])
    • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Iatrogenic Immunosuppression
    • Leukemia
    • Lymphoma (see Lymphoma, [[Lymphoma]])
    • Malignancy
    • Multiple Myeloma (see Multiple Myeloma, [[Multiple Myeloma]])
    • Nephrotic Syndrome (see Nephrotic Syndrome, [[Nephrotic Syndrome]])
    • Solid Organ Transplant

Intervals and Sequence of Pneumococcal Vaccinations (MMWR, 2015) [MEDLINE]

  • Asplenia/CKD/Cochlear Implant/CSF Leak/Immunocompromised at Any Age and Have Not Received Either PCV13 or PPSV23
    • Now: PCV13
    • 8 Weeks Later: PPSV23
  • Asplenia/CKD/Cochlear Implant/CSF Leak/Immunocompromised at Any Age and Have Previously Received PPSV23
    • 1 Year After PPSV23 Dose: PCV13
  • Age ≥65 y/o without Above Conditions
    • 1 Year After PCV13 (and at Least 5 Years After Last PPSV23): PPSV23
  • Age <65 y/o and Requiring Revaccination (i.e. Immunocompromised)
    • PPSV23 Should Be Given at Least 8 Weeks After PCV13 and at Least 5 Years After Last PPSV23 Dose

Revaccination

  • Immunocompetent
    • Age ≥65 y/o: all adults ≥65 y/o should be revaccinated, even if they were vaccinated before age 65 (with a minimum of 5 years between PPSV23 doses)
  • Immunocompromised: patients in these groups <65 y/o should be revaccinated one time (with a minimum of 5 years between PPSV23 doses) and again after age 65 (with a minimum of 5 years between PPSV23 doses)
    • Asplenia (see Asplenia, [[Asplenia]])
      • Sickle Cell Disease/Other Hemoglobinopathy
      • Congenital/Acquired Asplenia
    • Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
    • Congenital/Acquired Immunodeficiency
      • B-Cell/T-Cell Deficiency
      • Complement Deficiency (Especially C1, C2, C3, and C4)
      • Phagocytic Disorders (Excluding Chronic Granulomatous Disease)
    • Hodgkin’s Disease (see Hodgkin’s Disease, [[Hodgkins Disease]])
    • Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Iatrogenic Immunosuppression
    • Leukemia
    • Lymphoma (see Lymphoma, [[Lymphoma]])
    • Malignancy
    • Multiple Myeloma (see Multiple Myeloma, [[Multiple Myeloma]])
    • Nephrotic Syndrome (see Nephrotic Syndrome, [[Nephrotic Syndrome]])
    • Solid Organ Transplant

Treatment

Community-Acquired Pneumonia (CAP)


References

General

Vaccination